EP2433675B1 - Active implantable medical device including a means for wireless communication via electric pulses conducted by the interstitial tissue of the body - Google Patents

Active implantable medical device including a means for wireless communication via electric pulses conducted by the interstitial tissue of the body Download PDF

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Publication number
EP2433675B1
EP2433675B1 EP20110178361 EP11178361A EP2433675B1 EP 2433675 B1 EP2433675 B1 EP 2433675B1 EP 20110178361 EP20110178361 EP 20110178361 EP 11178361 A EP11178361 A EP 11178361A EP 2433675 B1 EP2433675 B1 EP 2433675B1
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Prior art keywords
pulse
device
pulses
means
alternation
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German (de)
French (fr)
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EP2433675A1 (en
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Ashutosh Ghildiyal
Renzo Dal Molin
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Sorin CRM SAS
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Sorin CRM SAS
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61NELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00Electrotherapy; Circuits therefor
    • A61N1/18Applying electric currents by contact electrodes
    • A61N1/32Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/372Arrangements in connection with the implantation of stimulators
    • A61N1/37211Means for communicating with stimulators
    • A61N1/37217Means for communicating with stimulators characterised by the communication link, e.g. acoustic or tactile
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Detecting, measuring or recording for diagnostic purposes; Identification of persons
    • A61B5/0002Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network
    • A61B5/0026Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network characterised by the transmission medium
    • A61B5/0028Body tissue as transmission medium, i.e. transmission systems where the medium is the human body
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Detecting, measuring or recording for diagnostic purposes; Identification of persons
    • A61B5/0002Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network
    • A61B5/0031Implanted circuitry
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61NELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00Electrotherapy; Circuits therefor
    • A61N1/18Applying electric currents by contact electrodes
    • A61N1/32Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/372Arrangements in connection with the implantation of stimulators
    • A61N1/37211Means for communicating with stimulators
    • A61N1/37252Details of algorithms or data aspects of communication system, e.g. handshaking, transmitting specific data or segmenting data
    • A61N1/37288Communication to several implantable medical devices within one patient
    • HELECTRICITY
    • H04ELECTRIC COMMUNICATION TECHNIQUE
    • H04BTRANSMISSION
    • H04B13/00Transmission systems characterised by the medium used for transmission, not provided for in groups H04B3/00 - H04B11/00
    • H04B13/005Transmission systems in which the medium consists of the human body
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2562/00Details of sensors; Constructional details of sensor housings or probes; Accessories for sensors
    • A61B2562/16Details of sensor housings or probes; Details of structural supports for sensors
    • A61B2562/162Capsule shaped sensor housings, e.g. for swallowing or implantation
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Detecting, measuring or recording for diagnostic purposes; Identification of persons
    • A61B5/02Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/021Measuring pressure in heart or blood vessels
    • A61B5/0215Measuring pressure in heart or blood vessels by means inserted into the body
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Detecting, measuring or recording for diagnostic purposes; Identification of persons
    • A61B5/04Measuring bioelectric signals of the body or parts thereof
    • A61B5/0402Electrocardiography, i.e. ECG
    • A61B5/0408Electrodes specially adapted therefor
    • A61B5/042Electrodes specially adapted therefor for introducing into the body
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Detecting, measuring or recording for diagnostic purposes; Identification of persons
    • A61B5/103Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
    • A61B5/11Measuring movement of the entire body or parts thereof, e.g. head or hand tremor, mobility of a limb
    • A61B5/1118Determining activity level
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Detecting, measuring or recording for diagnostic purposes; Identification of persons
    • A61B5/145Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue
    • A61B5/14542Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue for measuring blood gases
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61NELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00Electrotherapy; Circuits therefor
    • A61N1/18Applying electric currents by contact electrodes
    • A61N1/32Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/372Arrangements in connection with the implantation of stimulators
    • A61N1/37205Microstimulators, e.g. implantable through a cannula
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61NELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00Electrotherapy; Circuits therefor
    • A61N1/18Applying electric currents by contact electrodes
    • A61N1/32Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/372Arrangements in connection with the implantation of stimulators
    • A61N1/37211Means for communicating with stimulators
    • A61N1/37252Details of algorithms or data aspects of communication system, e.g. handshaking, transmitting specific data or segmenting data
    • A61N1/3727Details of algorithms or data aspects of communication system, e.g. handshaking, transmitting specific data or segmenting data characterised by the modulation technique

Description

  • The invention relates generally to the field of "active medical devices" as defined by the Council of European Communities Directive 93/42 / EC of 14 June 1993, and in particular "active implantable medical devices" as defined by Council Directive 90/385 / EEC of 20 June 1990.
  • This definition includes in particular the devices responsible for monitoring cardiac activity and generating pacing, resynchronization, defibrillation and / or cardioversion pulses in the event of arrhythmia detected by the device. It also includes neurological devices, cochlear implants, etc., as well as devices for measuring pH or intracorporeal impedance (such as measurement of transpulmonary impedance or intracardiac impedance).
  • The invention relates more particularly to those devices which implement implanted autonomous capsules and devoid of any physical connection to an implanted main device (such as a stimulation pulse generator box) or non-implanted device (external device such as as programmer or monitoring device for remote monitoring of the patient). The communication, conducted by the interstitial tissues of the body, is then of the so-called "HBC" type (Human Body Communication ).
  • These autonomous capsules are named for this reason " leadless capsules ", to distinguish them from the electrodes or sensors arranged at the distal end of a probe (lead), this probe being traversed along its length by one or more connecting conductors by Galvanically route the electrode or sensor to a generator connected to the opposite, proximal end of the probe.
  • Such leadless capsules are for example described in US 2007/0088397 A1 and WO 2007/047681 A2 (Nanostim, Inc.) or in the US 2006/0136004 A1 (EBR Systems, Inc.).
  • These leadless capsules may in particular be epicardial capsules, attached to the outer wall of the heart, or endocardial capsules, attached to the inner wall of a ventricular or atrial cavity. Their attachment to the cardiac wall is usually done by means of a protruding helical anchoring screw, axially extending the body of the capsule and intended to penetrate into the heart tissue by screwing to the implantation site.
  • Such a capsule includes detection / stimulation circuits to collect myocardial depolarization potentials and / or to apply stimulation pulses to the site where the capsule is implanted. The capsule then carries a suitable electrode, which can be constituted in particular by an active part of the anchor screw. It may also incorporate one or more sensors for locally measuring the value of a parameter such as the level of oxygen in the blood, the endocavitary cardiac pressure, the acceleration of the cardiac wall, the acceleration of the patient as an indicator of activity etc. Of course, to enable remote data exchange, these capsules incorporate wireless communication transmitter / receiver means.
  • The invention is however not limited to a particular type of capsule, and it is applicable regardless of any type of leadless capsule , regardless of its functional purpose.
  • Several techniques have been proposed to ensure the wireless communication between these autonomous capsules and a remote device for centralizing the information collected by the capsules and send them if necessary appropriate commands. This device may include a pacemaker, resynchronizer or implanted defibrillator, a subcutaneous defibrillator, or a long-duration recorder.
  • So, the US 2006/0136004 A1 proposes to transmit the data by acoustic waves propagating inside the body. This technique is effective and safe; however, it has the disadvantage of requiring a relatively high transmission power given the attenuation of acoustic waves in the body, and allows a relatively low data rate.
  • The US 5,411,535A proposes another technique, based on the use of radiofrequency (RF) waves. Here again, a relatively large emission power is required, and the attenuation of these waves by the intracorporeal tissues is an important obstacle to their propagation.
  • Another technique has been proposed by the US 4,987,897 A , but it is a data exchange with an external device (programmer), transcutaneously and not intracorporeally. This transmission is provided at a short distance between, on the one hand, the housing of a pacemaker implanted in a subcutaneous pocket and, on the other hand, an external programmer disposed near this generator. The currents circulate through the skin in a region far removed from sensitive areas, especially at a distance from the myocardium, which avoids any risk of disturbance of natural or stimulated depolarization waves of the latter.
  • The US 2007/0088397 A1 proposes also using the stimulation pulses produced by a capsule as a vehicle for the transmission of data previously collected or developed by the capsule. For this, the pulse, instead of having a monotonic variation of voltage, is interrupted in a controlled manner for very short periods of time so as to create in the profile of the pulse very narrow slots whose succession corresponds to a binary coding information to be transmitted.
  • This technique makes it possible to take advantage of the high energy of the stimulation pulses to overcome the problems of attenuation within the interstitial tissues between the capsule and the device.
  • However, it has a number of disadvantages, among which:
    • limitation to the emission of data by an active capsule generating pulses: in the absence of generated pulses, it is not possible to transmit any data since the pulse is the vehicle of the information;
    • limitation to a situation where stimulation is permanent; otherwise it is impossible to transmit data continuously, for example electrical signals collected by the capsule or values followed by a sensor integrated in the capsule;
    • limiting to a unidirectional communication, the active capsule producing the pulse to the remote receiver device, but not in the opposite direction;
    • low data rate, limited to a few bits of information per pulse, and unable to transmit information at a higher rate than that of stimulation pulses.
  • The US 2002/0099423 A1 discloses an intracorporeal wireless communication technique between an implanted medical device and an external device provided with electrodes in contact with the patient's skin. The implant generates electrical pulse trains whose level is below the stimulation threshold and applies these pulses to electrodes to propagate to the patient's body surface, where they will be picked up by the patient. the electrodes of the external device and then decoded by the latter.
  • This technique has several disadvantages, including a relatively high consumption and very high variability depending on the load resistance seen by the implant between its pulse emitting electrodes. Moreover, and especially, even with biphasic pulses (as this document provides), there is a high risk that residual charges will remain, due to imperfect balancing of the positive and negative charges generated by the pulses. These residual charges will produce a polarization within the tissues, creating a risk for the patient.
  • For these reasons, this technique is not suitable for permanent communication between medical devices, especially between two implants (which presupposes that the pulses pass through excitable regions of the myocardium). It is moreover proposed only for a communication between an implant and an external device transcutaneously, out of danger zones. On the other hand, in the case of a brief and temporary communication (the external device is for example used to raise the level of the implant's battery from time to time), a rather high consumption is not a critical factor. .
  • The object of the invention is to propose a wireless communication technique intracorporeally between implantable medical devices, typically between a leadless capsule and an implanted concentrator device, by means of signals consisting of electrical pulses able to be driven by the interstitial tissues of the body, a technique that overcomes the aforementioned drawbacks and provides the following advantages:
    • possibility of communication by any type of leadless capsule ,
    • total safety for the patient, even in the case of signals transmitted within myocardial tissues;
    • technique requiring little energy to establish communication, including compatible with the relatively low autonomy of the leadless capsules , dependent on an integrated self-feeding system;
    • high data rate;
    • no risk of disturbances by parasitic electrical signals present in the body tissues, including disturbances by the myopotentials present in the body.
  • For this purpose, the invention proposes an active implantable medical device of the general type disclosed by the US 2002/0099423 A1 aforementioned, that is to say comprising means for wirelessly communicating intracorporeally with at least one other active implantable medical device by means of signals consisting of electrical pulses able to be driven by the interstitial tissues of the body. This device comprises: at least one pair of electrodes; generating means capable of generating pulse trains formed from a succession of said electrical pulses; modulator means adapted to modulate the pulse trains by digital information produced by the device, the pulses being biphasic pulses comprising a positive alternation and a negative alternation; and means for injecting the pulses between the electrodes.
  • In a characteristic manner of the invention, the biphasic pulses are current pulses produced by a regulated constant current source included in the generator means.
  • According to various advantageous subsidiary features:
    • each positive and negative alternation of the biphasic current pulse is of square shape;
    • the negative alternation of the biphasic current pulse follows the positive alternation of this same pulse or vice versa;
    • the negative and positive alternations of the biphasic current pulse are symmetrical alternations;
    • the pulses of the pulse train are generated alternately in the order of the polarities of the alternations from one pulse to the next, so that a pulse whose positive half-cycle precedes the negative half-cycle is followed by a consecutive pulse whose negative alternation precedes the positive alternation and vice versa: one can thus have a positive (negative) pulse followed by a negative (positive) pulse followed by a negative (positive) pulse followed by a positive (negative) pulse;
    • the modulator means are means capable of modulating the time interval between pairs of consecutive biphasic current pulses of the pulse train, or the width of these pulses, or their amplitude;
    • the duration of the biphasic current pulse is between 0.1 and 30 μs, preferably 0.5 μs, the period of recurrence of the biphasic current pulses is between 2 μs and 2 ms, preferably 2 μs, and the amplitude of each of the positive and negative halfwaves of the current pulse is between 30 pA and 20 mA, preferably 10 mA.
  • An embodiment of the invention will now be described with reference to the appended drawings in which the same reference numerals designate elements that are identical or functionally similar from one figure to another.
    • The Figure 1 schematically illustrates a set of medical devices including leadless capsules , implanted within the body of a patient.
    • The Figure 2 shows more precisely how to implant these leadless capsules on the inner or outer wall of the myocardium.
    • The Figure 3 is a functional block diagram showing the different constituent stages of a leadless capsule .
    • The Figure 4 illustrates the waveforms allowing wireless communication intracorporeally according to the technique of the invention.
    • The Figure 5 schematically illustrates the elements on the transmitter side and receiver side necessary for the implementation of the invention.
    • The Figure 6 schematically illustrates a circuit for generating the current pulses for intracorporeal communication.
    • The Figure 7 illustrates the chronograms of sequencing of the various switches of the circuit of the Figure 6 .
    • The Figure 8 illustrates the demodulator circuit for decoding the pulses generated by the transmitter circuit.
    • The Figure 9 illustrates timing diagrams of signals taken from different locations of the demodulator of the Figure 8 and explaining how it works.
  • An embodiment of the invention will now be described.
  • On the Figure 1 there is illustrated a set of medical devices implanted within the body of a patient, communicating with each other wirelessly via "HBC" (Human Body Communication, intracorporeal communication).
  • The patient is equipped for example with an implant 10 such as an implanted defibrillator / stimulator / resynchronizer, or a subcutaneous defibrillator, or a long-term recorder. This implanted device 10 is the master device of a network comprising a plurality of slave devices 12 to 18 with which it is capable of communicating via the HBC channel. These devices may in particular include intracardiac or epicardial capsules 14 implanted directly on the patient's heart, other devices 16 such as myopotential sensors or neurological stimulation devices, and possibly an external device 18 disposed on a cuff and provided with electrodes in contact with the skin. The device 10 can also be used as a gateway with the outside world to communicate with an external device 20 of the programmer type or data teletransmission device with which it can communicate including RF telemetry in the band MICS (Medical Implants Communication System) 402-405 MHz, or the public ISM (Industrial, Scientific and Medical) 863-870 MHz, 902-928 MHz and 2.4 GHz public standard bands used by medical devices.
  • Each of the devices 10 to 18 is provided with at least a pair of electrodes which are in direct contact with the body tissues for the devices implanted, or in contact with the skin for the external device 18.
  • On the Figure 2 , there is shown an example of leadless type capsules implanted either on the anterior part of the myocardium, inside an atrial or ventricular cavity (endocavitary capsules 12), or on an outer wall of the same myocardium (epicardial capsules 14 ). These capsules, which are for example described in US 2007/0088397 A1 , WO 2007/047681 A2 and US 2006/0136004 A1 above, are attached to the cardiac wall by means of a protruding anchoring screw intended to penetrate into the heart tissue by screwing to the implantation site. The screw can be either a passive screw, serving only for fixing the capsule, or an active screw, used to collect the depolarization signals propagating in the myocardial tissues and / or to deliver stimulation pulses to the site implantation, in a localized way.
  • The Figure 3 schematically illustrates the various internal circuits of the capsules 12, 14 (and, mutatis mutandis, other implanted elements provided for communicating with each other by the technique of the invention). Each capsule has a pair of electrodes 22, 24, one of which may also be constituted by the anchor screw in the heart tissue. These electrodes are connected to a stimulation pulse generator circuit 26 (for an active capsule incorporating this function) and / or to a detection circuit 28 used to collect the depolarization potentials collected between the electrodes 22 and 24. A central circuit 30 controls the various functions, the memorization of the signals collected, etc. The capsule may also be provided with a sensor 32 such as a sensor for acceleration, pressure, a hemodynamic sensor, temperature, oxygen saturation, etc. The capsule is powered by a small battery or a power recovery circuit 34 supplying the circuitry via a power management stage 36.
  • In a characteristic manner of the invention, the electrodes 22 and 24 are, in all cases, also connected to a modulator / demodulator circuit 38 coupled to the central processor circuit 30 and able to transmit and / or receive pulses for communication without HBC wire, these pulses having characteristics of the invention, which will be described below.
  • Depending on whether the stimulation circuits (module 26) and collection circuits (module 28) are present or not, the electrodes 22, 24 can provide a simple, double or triple function, namely: stimulation and / or collection of cardiac potentials (the optionally) ; and / or transmission of the information tracked by the sensor 32 (if applicable); and send / receive for HBC communication (in any case).
  • The circuit 30 includes all electronics for controlling the various functions of the capsule. It comprises a microcontroller and an oscillator generating the clock signals necessary for the operation of the microcontroller and for communication. It can also contain an analog / digital converter and a digital storage memory.
  • The Figure 4 illustrates an exemplary pulse produced by circuit 38 for providing HBC communication by means of electrical pulses driven by the interstitial tissues of the body.
  • Characteristically, (i) these pulses are current pulses, and (ii) each pulse generated is a biphasic pulse, in order to minimize the residual charges injected into the core or to reduce the corrosion of the materials.
  • In the illustrated examples Figure 4 these pulses comprise two successive alternations, positive and negative, of square and symmetrical forms (same amplitude in absolute value, same duration for the two alternations). Other waveforms are, however, conceivable, and the example set forth herein is not limiting.
  • Still in this example, pulse modulation results from the variable time interval separating consecutive two-phase current pulse pairs from a pulse train generated by the device. Each pulse is defined by the succession, of constant duration T 0 , of two alternations of opposite sign. This pulse is followed by a respectively short wait T 1 , for example to code a binary '0', or long T 2 , to encode a '1' binary.
  • Other types of modulation can however be envisaged, for example a modulation of the amplitude of the pulses, of the width of the alternations (modulation of the PWM type), instead of the modulation described here consisting of modulating the time interval T 1 or T 2 separating consecutive current pulse pairs of a given pulse train.
  • The biphasic pulse can consist of a positive alternation followed by a negative alternation ( Figures 4a and 4c ), or a negative alternation followed by a positive alternation ( Figures 4b and 4d ). Advantageously, to minimize the residual charges that may result from the imperfections of a biphasic pulse not exactly symmetrical, after emitting a pulse of a first type (for example positive and negative alternation, as on the Figures 4a or 4c ), the next pulse can be an inverse type of impulse (negative alternation then positive alternation, as on the Figures 4b or 4d ), or no inverse.
  • This will compensate exactly the possible injection of residual charges to each bit of information sent, thus respecting medical standards and ensuring the safety of the impulses issued.
  • In addition, an error check can be implemented on the receiver side by checking the systematic presence of this alternating pattern within the received pulse train.
  • The biphasic pulses are emitted in succession in the form of pulse trains at a relatively high frequency, typically at a rate of one bit every 2 μs. The duration T 0 of the pulse is of the order of 1000 ns, a value which proves to be suitable for efficient transmission within the human body.
  • The choice of a repetition frequency of the order of 500 kHz (1 bit every 2 μs on average) makes it possible to adapt the spectral content to the particular transmission channel constituted by the interstitial tissues of the body, which has a minimum attenuation relatively moderate in the band 500 kHz-10 MHz (band B). In general, the attenuation in this frequency band varies between 10 dB and 40 dB, depending on the distance between transmitter and receiver, the spacing between the respective electrodes of the pair of electrodes and the surface of these electrodes, with a value typical of the order of 20 dB at 1 MHz over a distance of 10 to 12 cm between transmitter and receiver.
  • The Figure 5 schematically illustrates the means used to transmit and receive the biphasic pulses just described.
  • The transmitter circuits 40 are located in the leadless stimulator , or in the subcutaneous apparatus, responsible for monitoring cardiac activity and generating pacing, resynchronization, defibrillation and / or cardioversion pulses. They comprise a source 42 of constant current of the order of 10 mA, periodically adjustable or on command depending on the resistance of the probe connected to the core to generate at the end of the pulse a voltage of 2 V for example. The control module 30 controls the opening and closing of switches, in particular the closing of the switch 44 in order to inject the current over a predetermined time interval, for example of the order of 0.5 μs. The injected current 52 will flow (via the connection capacitor 46, shared or not with the stimulation stage, to avoid any sending of DC voltage to the electrodes) through the body of the patient from one of the electrodes 22 until 24. The switch 48 then discharges the capacitor 46 from the residual charge due to the compensation errors of the positive and negative pulses. After having thus injected a first alternation, the same procedure is followed to inject the following alternation by inverting the direction of the current, to obtain a pulse of the type of those illustrated. Figure 4 .
  • Reference 50 designates the circuits used on the receiver side. The current flowing in the body generates between the electrodes 22 'and 24' of the receiver a potential difference which is applied to an amplifier stage 54 via the connecting capacitors 56 and 58 making it possible to eliminate any DC component. The amplifier will only be powered during periods when data is being obtained to reduce power consumption. The resulting amplified signal is applied to a bandpass filter 60 to filter the spurious signals out of the relevant band. The filtered signal obtained is applied to a threshold comparator 62 and to a demodulator stage 64 (these circuits will be described in more detail with reference to FIG. Figures 8 and 9 ).
  • The Figures 6 and 7 illustrate a schematic diagram of two-phase current generator. The constant current source 42 is connected to the electrodes 22 and 24 by two switches SW 1 and SW 2 and by the connection capacitors 46 and 46 ', themselves connected to ground via two switches SW 3 and SW 4 . The Figure 7 give the chronograms different control signals S 1 to S 4 respectively applied to the switches SW 1 to SW 4 (the switch being closed when the signal is high). The figure 7 also indicates the profile of the current I flowing between the two electrodes 22 and 24. On this timing diagram, two successive biphasic pulses, symmetrized, with reversal of the sequence of alternations (positive-then-negative, negative-then- positive) from one pulse to the next. Finally, the period referenced OCD corresponds to the discharge of the output capacitors, which is operated via switches SW 3 and SW 4 . In the case where the capacitors 46 and 46 'are shared with the stimulation stage, the OCD discharge will be in refractory period only, because of its longer duration.
  • The Figure 8 describes an example of a demodulator for decoding pulses such as those illustrated Figure 4 , that is to say whose binary coding '0' or '1' corresponds to a respectively short waiting time T 1 or long T 2 from one pulse to the next. This demodulator 64 receives the data from the comparator 62. The data IN is then applied to an inverter 70 whose output IN / controls a flip-flop 72 whose Q output and the complementary output Q / are connected to the gate of respective symmetrical transistors 74 and 76. Each of these transistors charges a capacitor 78 or 80 by a resistor 82 or 84. The common-point voltage P 1 or P 2 of each capacitor-resistor assembly is applied to the input of a respective comparator circuit 86 or 88 whose other input is connected to a threshold reference voltage V th . The outputs O 1 and O 2 of the comparators 86 and 88 are applied to an OR circuit 90 whose output S is such that, when the load of one or the other capacitor 78 or 80 reaches the threshold value V th , the demodulator 64 transmits an output pulse O, which will go to zero with the falling edge of the input signal IN.
  • The last line of the Figure 9 showed how we can decode a binary word '010010'.

Claims (11)

  1. Active implantable medical device, comprising means for wirelessly communicating by intracorporeal pathway with at least one other active implantable medical device via signals consisting of electrical pulses which can be conducted by the interstitial tissues of the body, this device (12, 14) comprising:
    - at least one pair of electrodes (22, 24);
    - generator means, capable of generating pulse trains formed by a succession of said electrical pulses;
    - modulator means, which can modulate the pulse trains by digital information produced by the device,
    the pulses being biphasic pulses comprising a positive alternation and a negative alternation; and
    - means for injecting the pulses between the electrodes (22, 24),
    the device being characterized in that said biphasic pulses are current pulses produced by a regulated constant current source (42) included in the generator means (44, 48).
  2. Device of Claim 1, in which each positive and negative alternation of the biphasic current pulse is of square form.
  3. Device of Claim 1, in which the negative alternation of the biphasic current pulse follows the positive alternation of this same pulse, or vice versa.
  4. Device of Claim 1, in which the negative and positive alternations of the biphasic current pulse are symmetrical alternations.
  5. Device of Claim 1, in which the pulses of the pulse train are generated with alternation of the order of the polarities of the alternations from one pulse to the next, so that a pulse whose positive alternation precedes the negative alternation is followed by a consecutive pulse whose negative alternation precedes the positive alternation, and vice versa.
  6. Device of Claim 1, in which the modulator means are means which can modulate the time interval (T1, T2) separating pairs of consecutive biphasic current pulses of the pulse train.
  7. Device of Claim 1, in which the modulator means are means which can modulate the width of the successive biphasic current pulses of the pulse train.
  8. Device of Claim 1, in which the modulator means are means which can modulate the amplitude of the successive biphasic current pulses of the pulse train.
  9. Device of Claim 1, in which the duration (T0) of the biphasic current pulse is between 0.1 and 30 µs, preferably 0.5 µs.
  10. Device of Claim 1, in which the period of recurrence of the biphasic current pulses is between 2 µs and 2 ms, preferably 2 µs.
  11. Device of Claim 1, in which the amplitude of each of the positive and negative alternations of the current pulse is between 30 µA and 20 mA, preferably 10 mA.
EP20110178361 2010-09-24 2011-08-22 Active implantable medical device including a means for wireless communication via electric pulses conducted by the interstitial tissue of the body Active EP2433675B1 (en)

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US9694189B2 (en) 2014-08-06 2017-07-04 Cardiac Pacemakers, Inc. Method and apparatus for communicating between medical devices
US9757570B2 (en) 2014-08-06 2017-09-12 Cardiac Pacemakers, Inc. Communications in a medical device system
US9808631B2 (en) 2014-08-06 2017-11-07 Cardiac Pacemakers, Inc. Communication between a plurality of medical devices using time delays between communication pulses to distinguish between symbols
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US10328272B2 (en) 2016-05-10 2019-06-25 Cardiac Pacemakers, Inc. Retrievability for implantable medical devices
US10029107B1 (en) 2017-01-26 2018-07-24 Cardiac Pacemakers, Inc. Leadless device with overmolded components

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